Benzylpenicillin versus flucloxacillin for penicillin susceptible Staphylococcus aureus bloodstream infections from a large retrospective cohort study.
Int J Antimicrob Agents. 2019 Jun 07;:
Authors: Henderson A, Harris P, Hartel G, Paterson D, Turnidge J, Davis JS, Tong SYC
In clinical practice, differing opinion exists as to the optimal management of patients with penicillin susceptible Staphylococcus aureus (PSSA) bloodstream infections (BSIs). The aim of this study was to compare 30-day mortality of patients treated with benzylpenicillin or flucloxacillin. We compared 30-day mortality for patients treated with flucloxacillin or benzylpenicillin for PSSA BSIs from a large prospective data set from Australia and New Zealand. We used a logistic regression model and a propensity score treatment analysis using inverse probability of treatment weighting. 915 patients were included in the study with an overall mortality rate of 12.9% (benzylpenicillin 10.5%, 33/315 and flucloxacillin 14.2%, 85/600). Endocarditis was associated with benzylpenicillin treatment choice, whereas dialysis and skin and soft tissue infection was associated with flucloxacillin treatment. In the multivariate analysis, an increased mortality was associated with flucloxacillin compared to benzylpenicillin (OR 1.6, 95% CI 1.0 - 2.5, p = 0.05). When adjusted for treatment choice in the propensity score analysis, flucloxacillin was again associated with increased mortality (OR 1.05, 95% CI 1.01 - 1.1, p = 0.03). An increase in 30-day mortality associated with flucloxacillin use suggests a potential benefit for benzylpenicillin therapy in patients with PSSA BSIs.
PMID: 31181352 [PubMed - as supplied by publisher]